Delivery System Transformation Efforts Presented to IHA
HMA has worked on delivery system transformation across the country and developed principles for the Hospital Transformation Program in Illinois. Transformation examples from various states like New York, Texas, Louisiana, Los Angeles, and South Carolina are presented, along with case studies such as MLK Hospital in Los Angeles and lessons learned from New York's DSRIP. The content focuses on community needs assessments, partnerships, shaping systems, funding, milestones, partnerships, workforce development, and sustainability.
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Presentation Transcript
Delivery System Delivery System Transformation Efforts Transformation Efforts Presented to the Illinois Health and Hospital Association By Pat Terrell and Jim Parker June 18, 2018
AGENDA HMA scope Reform examples New York Texas Louisiana Los Angeles South Carolina Summary principals 2
HMA BACKGROUND HMA has worked on delivery system transformation at all levels across the country For states For local governments For large systems For smaller providers IHA requested that HMA use this experience to help develop principles to be used as Illinois moves forward with the Hospital Transformation Program in the assessment bill. 3
Transformation Examples from other states 4
MLK HOSPITAL IN LOS ANGELES Problem poor quality care at hospital lack of access to needed services for the community Process: Community Needs Assessment Utilization patterns Staff assessment Result New ambulatory center and new hospital New lines of service Coordination between all community providers 5
MLK LESSONS LEARNED Reform starts with community needs assessment Need partnerships across full continuum of care System should be shaped to meet needs and not the capabilities of providers 6
NEW YORK DSRIP Performing Provider Systems PPS had to choose from menu of projects Funds had to be earned by milestones Funds could be used for: Project costs Lost revenue P4P Other considerations Combined with APMs to help transformation 7
NY DSRIP LESSONS LEARNED Forcing the pace resulted in some bad decisions Funders must know what they want out of investments and make that clear Partnerships are essential but must be constructed thoughtfully MCOs need to be involved in process of reform Workforce development is critical to new models End product must be sustainable 8
TEXAS DSRIP Regional Healthcare Partnerships with lead provider Projects chosen from menu Infrastructure Model of care redesign Quality improvement Population focused improvements Payments tied to milestones and metrics Predetermined regions and need for lead provider created conflicts 9
LOUISIANA LESSONS LEARNED Path chosen was not based on thoughtful study Poor partners were chosen in some regions Almost complete dependence on special financing arrangements and payments calls sustainability into question 10
SOUTH CAROLINA RURAL HOSPITAL TRANSFORMATION State targeted eligible hospitals Projects required an advising hospital partner and a DSH hospital Requirements for transformation plans kept to a minimum to allow flexibility Partially funded through DSH allotment Advising hospital required to commit funds Funds set aside for consulting services 11
LOUISIANA Public hospital system was in need of significant reform Decision was made to turn it over to private partners Some partners ran hospitals and some public hospitals closed with private agreeing to serve Medicaid and uninsured Financed through a number of widely varying special payments deals 12
SOUTH CAROLINA LESSONS LEARNED There are funding mechanisms other than DSRIP Viable and committed partners enhance chance of success Consulting services help planning Accountability with flexibility 13
Conclusions and Discussion 14
PRINCIPLES LEARNED Proper planning is essential and planning must be heavily data based Demographic Utilization gaps and duplication Reform is about meeting needs of community across the continuum of care, not about meeting the needs of providers Delivery system reform is about the entire system and requires carefully thought through partnerships medical, behavioral and social Care in the right setting Sufficient volume to enhance quality Reduce the overall cost of care 15
PRINCIPALS Investment needed to transform but new system must be sustainable with rational payment systems Accountability has to be in place before funds delivered payments upon milestones or metrics Broader impact on community should be recognized and mitigation considered 16
DISCUSSION Questions 17
